<div class="modal-header">Đăng Ký</div>
<div class="modal-body">
    <form role="form" action="<?php echo $this->element->getAction();?>" method="post">
        <div class="input-group form-group">
            <span class="input-group-addon"><span class="glyphicon glyphicon-user" style="color:red;"></span></span>                                                                        
            <?php echo $this->element->username?>            
        </div>
        <div class="input-group form-group">
            <span class="input-group-addon"><span class="glyphicon glyphicon-envelope" style="color:red;"></span></span>                                    
            <?php echo $this->element->email?>                                    
        </div>
        <div class="input-group form-group">
            <span class="input-group-addon"><span class="glyphicon glyphicon-lock" style="color:red;"></span></span>                                    
            <?php echo $this->element->password?>                                    
        </div>  
        <div class="input-group form-group">
            <span class="input-group-addon"><span class="glyphicon glyphicon-earphone" style="color:red;"></span></span>                                    
            <?php echo $this->element->mobile?>                                    
        </div>  
        <div class="input-group form-group">
            <span class="input-group-addon"><span class="glyphicon glyphicon-user" style="color:red;"></span></span>                                    
            <?php echo $this->element->fullname?>                                    
        </div>            
        <div class="input-group form-group">
            <span class="input-group-addon"><span class="glyphicon glyphicon-home"></span></span>                                    
            <?php echo $this->element->address?>                                    
        </div>   
                                   
        <img width="200" height="50" alt="" src="" style="margin-bottom:10px"/>
       
        <div class="input-group form-group">                                                                    
            <span class="input-group-addon"><span class="glyphicon glyphicon-qrcode" style="color:red;"></span></span>                                    
            <?php echo $this->element->captcha?>                                                                                                                                       
        </div>                                                                                                  
        <script>
            //$(document).ready(function(){                                                                                
                var imgUrl = $('input[type=text][name="captcha[input]"]').parent().find('img').attr('src');                                        
                $('input[type=text][name="captcha[input]"]').parent().parent().find('img').attr('src',imgUrl);
                $('input[type=text][name="captcha[input]"]').parent().find('img').attr('style','display:none');
            //});
        </script>                                
        <button type="submit" class="btn btn-primary">Đăng ký</button>
    </form>
</div>